To have or not to have sugar?
World Diabetes Day (WDD) takes place on November 14 and was created in 1991 by International Diabetes Federation and the World Health Organization in response to growing concerns about the escalating health threat posed by diabetes. WDD became an official United Nations Day in 2006 and is reaching a global audience of over 1 billion people in more than 160 countries.1
The theme for this year was ‘’education to protect tomorrow’’ because many people are still not aware of the predisposing factors of diabetes, how to prevent them, or the best management the disease once diagnosed.
The saying goes “if you educate a boy, you educate an individual. If you educate a girl, you educate a community”.
Lifestyle changes and globalisation have, during the past five decades, resulted in remarkable changes in societies, political systems, the environment, and human behaviour. The number of people with diabetes and obesity has increased substantially in both developed and developing countries with the greatest burden falling on socially disadvantaged groups and indigenous peoples. Diabetes ranks highly on the international health agenda as a global pandemic and as a threat to human health and global economies and has been termed “the diabetes apocalypse”2.
Background
Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which over time leads to serious damage to the heart, blood vessels, eyes, kidneys and nerves4. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to, or doesn’t make enough insulin4.Type 1 diabetes or insulin-dependent diabetes, once known as juvenile diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. The most common risk factors for diabetes include family history, age, being overweight, having a sedentary lifestyle, unhealthy diet, or use of alcohol or tobacco3. If ignored without proper management and no lifestyle modifications, diabetes can lead to heart attack, stroke, kidney failure, lower limb amputation, visual impairment, blindness, and nerve damage, including erectile dysfunction3. For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival4
Globally, 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year4. In the African Region, more than 19 million people are living with diabetes and this number is expected to grow to 47 million by 20253. Unfortunately, about 75% of people living with diabetes in African countries are oblivious to their condition. In the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. There is a globally agreed target to halt the rise in diabetes and obesity by 20254.
Figure 1: Diabetes is on the rise4
Globally, 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year4. In the African Region, more than 19 million people are living with diabetes and this number is expected to grow to 47 million by 20253. Unfortunately, about 75% of people living with diabetes in African countries are oblivious to their condition. In the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. There is a globally agreed target to halt the rise in diabetes and obesity by 20254.
Recognition of the challenge of diabetes
International health agencies and national governments ignored the rise of diabetes and other non-communicable diseases until quite recently. In 2011, the UN General Assembly made a political declaration on the prevention and control of non-communicable diseases (NCDs) which was followed by a call by the World Health Assembly to reduce avoidable mortality from NCDs by 25% by 20252.
Diagnosis rates need to be improved to achieve the World Health Organization’s (WHO) 25×25 Global Action Plan (2013) as well as Sustainable Development Goal (SDG) 3 to reduce premature deaths due to NCDs by a third by 20305.
The availability of medicines to treat patients with diabetes should improve with ongoing programs across Africa, including South Africa, to improve access to medicines in patients with chronic diseases as well as ongoing programs to reduce the costs of medicines as a barrier to their use. However, more remains to be done with continual concerns regarding the availability of metformin and insulins across Africa. Efficient procurement of medicines is critical to ensure that patients with diabetes within public healthcare systems are able to obtain an uninterrupted supply of their medicines.
Figure 2: Number of adults estimated to have diabetes by World Bank income group in 2011 and 2030, according to age
- Lose extra weight
- Get moving
- Eat healthy plant foods
- Eat healthy fats
Skip fad diets and make healthy choices
When to see the doctor
- People younger than 45 who are overweight or obese and have one or more risk factors associated with diabetes
- Women who have had gestational diabetes
- People who have been diagnosed with prediabetes
- Children who are overweight or obese and who have a family history of type 2 diabetes or other risk factors
Concerns with rising rates of diabetes and its impact will persist unless addressed. This includes access to diagnostic and monitoring equipment and essential medicines in the first place along with adequate diagnostic facilities given current concerns with diagnosis rates. Partnerships between public, private and development sectors and communities are required to tilt the dial, reverse the incidence and improve quality of life for people living with diabetes. These partnerships have to be respectful and based on established need whilst reducing redundancies and duplication.
Reference
[2] P. Z. Zimmet, D. J. Magliano, W. H. Herman, and J. E. Shaw, “Diabetes: A 21st Century challenge, ”The Lancet Diabetes & Endocrinology, vol. 2, no. 1, pp. 56–64, 2014
